More in College Seek Help For Psychological Problems

By ERICA GOODE

Published: February 3, 2003

A study of college students seeking psychological counseling has found that their emotional difficulties are far more complex and more severe than those seen in the past.

From 1989 to 2001, the percentage of students treated for depression doubled. So did the percentage of suicidal students, according to the study, conducted at the counseling center at Kansas State University. More than twice the percentage of students were taking some type of psychiatric medication, even though the absolute number of students seen by the center remained stable.

Problems related to stress, anxiety, learning disabilities like attention deficit disorder, family issues, grief and sexual assault also rose. The study also found accompanying increases in more traditional college complaints like trouble in separating from parents, romantic relationships or the choice of careers.

''What we're seeing is people with multiple problems, and some of those are significantly more serious,'' said Dr. Sherry A. Benton, the assistant director of training at the counseling center in Manhattan, Kan., and the lead author of the report, which appears today in the journal Professional Psychology: Research and Practice. The study was based on forms filled out by therapists after treating more than 13,000 students seen at the center between 1989 and 2001.

Mental health professionals at other college counseling services said the study, the largest of its kind and the first to look at specific categories of problems, confirmed their impressions that students are now struggling with more serious forms of distress.

In a 2002 national survey, more than 80 percent of 274 directors of counseling centers said they thought the number of students with severe psychological disorders had increased over the previous five years.

What lies behind the increase is not clear. A greater awareness of mental illness and the easing of the stigma attached to seeking psychiatric help may play a role. But experts also cite the pressures on students to succeed academically and the breakdown of family support systems as factors.

''People just don't seem to have the resources to draw upon emotionally to the degree that they used to,'' said Dr. Robert Portnoy, the director of counseling and psychological services at the University of Nebraska. ''What would once have been a difficult patch for someone in the past is now a full-blown crisis.''

Doris Bertocci, a social worker at Columbia University's counseling center, said about the Kansas State study, ''If anything, the conclusion understates the gravity of the problem.''

Columbia last year reported a 40 percent increase in the use of the counseling center since the 1994-95 academic year and has nearly doubled its staff, extended its hours and set up offices in dormitories. A spokeswoman said the number of students using the center had risen further in the last year. Other colleges have registered similar growth in demand.

Ms. Bertocci said many clients coming to the center suffered from depression, manic depression, panic attacks and eating disorders or were dealing with family issues, including physical or sexual abuse. Some, she said, were ''chronically suicidal.''

''Our impression,'' she added, ''has been that by the time students get to Columbia, many of them have had their emotional needs neglected by a lack of access to adequate mental health services.''

In the Kansas State study, the percentages of students with eating disorders, chronic mental disorders or who abused drugs or alcohol was not significantly higher in 2001 than in 1989. The percentage of students dealing with sexual or physical abuse from childhood increased sharply in the mid-1990's but then declined.

The prevalence of psychiatric problems on campus and the question of how much responsibility colleges have for the mental health of their students received wide attention two years ago, after highly publicized suicides at several institutions, including the Massachusetts Institute of Technology.

Many campuses have had sharp increases in psychiatric hospitalizations. For example, Dr. Portnoy said 15 to 20 students at Nebraska were now hospitalized each semester, up from 3 or 4 a decade ago. In the vast majority of those cases, he said, suicidal thoughts or actions precipitate the hospitalization.

In the 2002 national survey, the counseling service directors reported a total of 116 suicides at 55 colleges. Only 20 of those students, the survey respondents said, had been seen by college counseling centers before the suicides.

Dr. Benton, at Kansas State, said addressing the needs of suicidal students was one of the most taxing responsibilities that counseling center staff members have.

In 2002, she said, her center dealt with 96 students who were contemplating suicide or had made suicidal gestures or attempts.

''The amount of time and energy and resources that it takes is unbelievably high,'' Dr. Benton said. ''I've had a mother say about her occasionally suicidal son, 'I'm counting on you to keep him alive.' That's a lot of pressure.''

Ms. Bertocci, of Columbia, said that many of the students she sees require antidepressants or other psychiatric medication but cannot afford to pay for it and do not have insurance to cover the cost. Dr. Benton said that only about 30 percent of the students at Kansas State had health insurance. About 15 percent of college counseling centers charge students for individual counseling sessions.

Lindsay Gangwish, 23, saw a counselor at the University of Nebraska counseling center once a week during her four years at the university. She paid $20 per session for the first 25 sessions, she said, then $45 per session after that.

Ms. Gangwish, who graduated in December, said she sought counseling in her freshman year after having panic attacks and mood swings.

Eventually, bipolar disorder was diagnosed. She said the illness runs in her family.

But she added that the pressures of college had contributed to her difficulties.

''There's a lot of stress,'' she said. ''You hear a lot of people talking about the stress.''